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Our Future is Fantastic*
Arthur A Dugoni, D.D.S., M.S.D.**
dental schools in 1975 and only 7,000 in 1983. The recruitment of quality students must involve the entire profession.
It should also be noted that there will be a decrease in graduates from dental schools in the near future as we examine first year class enrollments. In 1978/79 there were 6,301 first year students enrolled in the nation’s dental schools, but in 1983 there were 5,257 first year students enrolled in dental schools. It is interesting to note that the 1983 first year class of 5,257 compares to the 5,337 students enrolled in first year classes in 1972/73.
The American Dental Association and constituent and component dental societies need to be visible at dental schools; facilitate an identity between the dental student and the organized profession and involve students in organized dentistry’s activities. If the profession is to continue to grow it needs to attract the very best dental students and provide the facilities and the faculty for innovative and progressive research.
Too often the profession has looked for someone else to do the job. We need to “light the fire” under every dentist in this country that they need to support scholarship and endowment programs for dental schools. Alumni must be made to realize that they paid only a small portion of the costs of their education. Alumni support will be the keystone for survival or continued excellence of many dental schools. A dentist is a dental student for four years, but an alumnus for the rest of his or her life.
The profession must take an active role in placement programs for young graduates. Our professional colleagues must provide associateship programs so that opportunities can be developed for young practitioners to earn a living and continue to grow professionally. Our young practitioners need an alternative within the private practice system to the entrepreneurial activities that they are currently being offered.
Intensive and organized recruitment programs are essential to convince young graduates that they must be members of organized dentistry.
Compared with real growth in the economy, the average dentist’s net income will experience only a modest rate of growth through the end of the century. Advertising will continue to influence the public’s perception. Changes in the modes and settings of practice will require adjustment by dentists and professional dental organizations. The majority of care will continue to be provided through the traditional private practice mode, but alternative delivery modes and settings will increase. General practitioners will expand their practices to include procedures previously performed by specialists. Group practices will continue to flourish and more independent groups of two or more separate practices sharing the same facilities will develop. However, in my opinion, solo fee for service private practice has a promising future and will continue to be the cornerstone of the private practice system.
The future of IPA’s, preferred provider and exclusive provider organizations will remain unclear as their ability to compete remains untested. Corporations will continue to experiment with providing care directly to their employees. Retail store dentistry will grow slowly, but their future will depend upon their productivity. We need to assess, design and be in the avant garde of alternate delivery modes. We cannot let others do it for us. It is not in the public interest. Preferred providers, exclusive providers, individual practice associations, and service corporations need our priority attention – we need to provide our dentists with the capability to compete ethically and with quality care in the marketplace.
Significant issues that will need our dynamic energies include freedom of choice legislation, waiver of copayment, preferred provider and exclusive provider organizations, procompetition, tax cap, or tax on health insurance premium type legislation, FTC power, experimental programs and inadequate health care funding, especially for state programs. We need to strengthen our contact alliance for initiative and referendum legislation that is not in the profession’s or the public’s interest. We need to maintain our legislative initiative and strategic planning to alter, modify or develop legislation on those significant issues that could destroy or reduce the quality of health care. We need to maintain our formidable and successful contacts with legislators, legislatures and legislative committees, but, we cannot rest on our laurels – we need to continue to monitor the vital signs. need to demand – provide access to care for the handicapped, the aged and the disadvantaged –we need to influence all aspects of the prepayment market, especially demand.
Demands for independent practice by hygienists and denturists will increase. In response to decreasing net income and attempts by dentists to reduce their overhead, the traditional role of auxiliaries will expand. New specialty areas will not be recognized or developed. The behavioral and psychological aspects of dental treatment will play an increasingly important role in patient management and motivation, and there will be an increased emphasis on the training of dentists and dental students to develop strong interpersonal skills.
More than 5,000 years ago a Sumerian found a better way. He invented the wheel, perhaps the world’s greatest single technological achievement. Since then, millions of individuals – some celebrated and some unknown, some by design and some by accident have found a better way. Thomas Edison found a better way: the incandescent lamp. Henry Ford: the mass produced automobile. Alexander Graham Bell: the telephone. Elisha Otis: the power elevator.
Oral health will be considered a part of overall general health. Dentistry will slowly evolve toward medicine with a heavier emphasis on prevention and the use of auxiliaries.
The need to market the profession to reduce the barriers to care will increase. California has set the example for the rest of the country. California’s marketing and institutional advertising programs has helped turn the corner of last year’s busyness problem. The impact of the marketing program goes far beyond paid advertising. The true impact is on the dentist and his or her staff and their own potential for marketing their services. Our profession has gone back into the people business, being visible, being available, sharing themselves and their knowledge with the community. The television, the billboards, the public service announcements, the health fairs, the school screenings, the communication marketing seminars, all renewed and rekindled our enthusiasm for our practices and our profession. We need to continue to influence the marketplace. If I had my way, we would allocate $1,000.00 per year, per member, for marketing. We must increase
The desire and the motivation to find a better way are an integral part of human nature. We Americans are especially known for our Yankee ingenuity. We are a nation constantly striving to find – and sometimes obsessed with finding a better way to do our jobs – to teach our children – to refine our goods – to sell our products – to interact with people – to maintain our health – to sell our skills and to stretch our endurance. The challenge for our profession in the 1980’s and the 1990’s will be to find a better way. A better way to market our profession, a better way to reduce barriers to care, a better way to fund education, student aid, and research, a better way to increase dental health care awareness and the dental health of all of our citizens. We need to continue to reach out for high technology and quality education and research – for innovation which has been the source of our wealth and for standards and quality of care which have made our profession the envy of the rest of the world. Our profession will not restrict tomorrow’s range of choices and will not dilute its capacity to solve tomorrow’s problems. I am convinced we will pay the price in dollars, time and leadership and we will find a better way.
But, first we need to renew our faith in ourselves and in our profession. Walter Cronkite appeared in San Francisco, before the Commonwealth Club, several months ago, and stated: “More than a century ago Walt Whitman wrote a poem about his country that began – I hear America singing – it has been a long while since any one claimed to hear America singing. There is a noise in the land, but it is made,
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Our Future is Fantastic*
Arthur A Dugoni, D.D.S., M.S.D.**
mainly, by Americans blaming each other for the mess we are in. As the decibel level rises, our confidence in ourselves and in our institutions falter. But, what I want to say is – shut up for a minute. Listen carefully and quietly for a while; you can still make out America singing, although the sound may be a little faint. The tune is there, and the spirit and the purpose are still there. This nation, groaning economically with unemployment, in a monstrous unprecedented deficit, nevertheless, puts out an annual product worth almost three trillion dollars. The gross national product of the next greatest economy is only 55% of that. Our national image has, indeed, been tarnished in recent years, but nobody is trying to crash the gates of the third world these days. A barbed wire around the Warsaw Pact is not there to keep immigrants out. America remains the beacon of liberty, the hope and model for most of those able to exercise any choice, at all. About half of the world’s people enjoy no freedom at all; no political and civil rights, nor economic freedom. During the lifetime of most of us, we have been swept in four simultaneous eras, any one of which could be enough to reshape our world. We have been present at the birth of the nuclear age, the computer age, the space age, and the petro-chemical age. It is a great plunging river of change, unlike anything that we have encountered before. We are living today, through a technological revolution, potentially more profound, socially, politically and economically than the industrial revolution. We have scarcely begun to identify its implications and adapt our institutions to cope. We can get this country moving with a full head of steam again, if we junk the partisan distinctions of the past, and look at our problems with a kind of principle pragmatism that this nation’s founders had to employ. We have the wherewithal, all we need is the will. It has been a while since anyone has claimed to hear American singing, but they knew something that we seemed to have forgotten: to hear the music, you also have to sing along.” During the last forty years we have seen great advances in our profession. We have been “singing along” – listen to the tune! Through scientific research, we have been able to realize how to care for and essentially prevent man’s major dental diseases. We have gone from ignorance to understanding in periodontal disease and dental decay and we have advanced dramatically in terms of the comprehensive care we are now able to offer each patient. Although the 1980’s will undoubtedly bring periods of retrenchment, this decade also promises the opportunity to use our knowledge, experience, and understanding in new and innovative ways, but we need to “sing along”. Perhaps one of the greatest things that will happen to our profession will be the reduction of the restorative needs of our patients, by fluoridation and preventive dentistry techniques. Dentistry’s future will be in periodontics, functional occlusion, oral pathology, chronic pain modalities, temporomandibular joint dysfunction, implantology, oral medicine, genetic engineering, behavioral sciences, care for the handicapped, care for the aged and disadvantaged, and preventive, functional and adult orthodontics. When these eventualities fully hit the profession, the horizons for service to mankind will be opened remarkably, and the opportunities for personal satisfaction and a sense of accomplishment will truly reflect what it means to be part of a learned profession – a doctor. This is an exciting time for our profession – it is a time of change and challenges. We should welcome change and savor the challenges, because they open up opportunities to shape the future of a great profession. Dentistry’s future is brighter than ever, and in another 40 years we will look back and reflect that the decades of the 1980’s and 1990’s were unsurpassed in the development of the dental professor.
References
1. In Search of Excellence; Thomas J. Peters, Robert H. Waterman, Jr.; Harper and Row Publishers, 1982.
2. Strategic Plan: Report of the American Dental Association’s Special Committee on the Future of Dentistry; July 1983
3. Megatrends: Ten New Directions Transforming Our Lives; John Naisbitt; Warner Books, 1982
4. ADDRESS, (Commonwealth Club); Walter Cronkite, 1983